Friday, February 26, 2010

Would you spend your entire paycheck on healthcare?

It is an absurd question, right? Well, not really. Bear with me for a bit.

As I half-listened to the White House healthcare summit yesterday, I was feeling the familiar sensation of nausea rising in response to the usual excuses and talking points from both sides. Talking at each other, parroting old memorized lines about the process rather than the substance, the illustrious group came away with no consensus. Nevertheless, this lack of results seems to be pushing the Democrats to plow through the opposition and unilaterally pass the legislation through the process of reconciliation. But will it be done well? This has always been the question.

I think this WSJ article from today has called our attention explicitly to something that has been hampering any sensible approach to the reform, the selfish blame game:

Insurers contend that they must pass on ever-higher bills from hospitals and doctors. Hospitals say they are struggling with more uninsured patients, demands by doctors for top salaries, and underpayments from Medicare and Medicaid.

And doctors say they are strong-armed by insurance monopolies and hampered by medical malpractice costs.

This is the ultimate case of missing the forest for the trees. Let's think about this in slightly different terms. You are noticing that your food bill is growing out of pace with your income, the growth of your family and the growth of the national inflation rates. Do you not stop and ask what is going on? And if the answer is that, without any other changes, your family is now consuming 20 pounds of potatoes per week, while 6 months ago you made do with 4 pounds, do you not stop and ask why? And if on top of that observation you have also noticed that your family is becoming obese, do you not stop and rethink what is going on? And if as you stop and think you notice that your obese family members are in fact making even more frequent trips to the kitchen to feed their increased hunger, do you not want to break the cycle?

Well, we are "eating" a lot more healthcare than we did 10 years ago, and in the next 10 years we are likely to be "eating"even more. If healthcare continue to grow at the current pace, we will be spending 100% of our income on healthcare before we know it; and on healthcare that continues to fall short of meeting our needs to boot. The levels of chronic disease in our society have never been higher, and the number of diseases that "require" treatment has never been more vast (think mild depression, erectile dysfunction, lactose intolerance, and many other marginal human woes, most best addressed by introspection and lifestyle modification). Reflecting this growth, our preoccupation with health and disease seems to be edging out other, far healthier pursuits. And the rhetoric of "best healthcare system in the world", emanating from the Republican opposition yesterday, is not only disingenuous, it is just stupid, especially coming from someone, in fact many someones, who should know better.

So, let's look at the big picture, folks. Let's walk away from the divisiveness of the blame game and get back to the basics. We are not the best, we are least accessible, and we are most expensive. In the world! Yes, we are special, we are Americans. But it is time to exercise that specialness by admitting the abject failure of this market experiment, get off our high horse of individuality and look to other nations and systems for a sensible solution. I for one am not willing to spend all of my time or money obsessing about my health. How about you?

Welcome and a disclaimer

Welcome to my blog, "Healthcare, etc."! In this blog I take the perspective of a researcher/policy wonk rather than an individual healthcare practitioner. Therefore, all opinions that I express and generalizations that I make about any issues will in no way be construed as medical advice for individual visitors / readers. All views expressed here are solely my own, and do not represent opinions of any organizations with which I am affiliated. I welcome all comments, but reserve the right not to publish paranoid or abusive rants or overt marketing pitches.

About Me

I am an independent physician health services researcher with a specific interest in healthcare-associated complications and a broad interest in the state of our healthcare system. I am also a professor of Epidemiology at the University of Massachusetts, Amherst.
I am frequently invited to speak about evidence-based medicine, methods and healthcare-associated complications.
My posts have been syndicated on The Health Care Blog, KevinMD,The Healthcare Collective and other sites. They have also been cited in the New York Times. Occasionally you can also find me blogging on the British Medical Journal blog site http://www.doc2doc.bmj.com
If you would like to contact me about my research, blog posts or speaking, please e-mail me at Healthcareetcblog@gmail.com